What is the best approach to manage dysgeusia (metallic taste) in a patient after chemotherapy?

Management of Metallic Taste (Dysgeusia) After Chemotherapy

The best approach to managing chemotherapy-induced metallic taste is to implement practical dietary modifications including using plastic utensils instead of metal, eating cold or frozen foods, adding strong herbs/spices/sweeteners/acids to foods, consuming sweet and sour foods together, and considering "miracle fruit" supplements, while also trialing zinc supplementation or medications such as clonazepam, megestrol acetate, or dronabinol for persistent symptoms. 1, 2

Understanding the Problem

Metallic taste is a common and distressing side effect of chemotherapy that affects 9.7% to 78% of cancer patients depending on the specific regimen, with particularly high rates in patients receiving cisplatin, carboplatin, cyclophosphamide, and 5-fluorouracil-based therapies. 1, 3, 4 Women experience this symptom more frequently than men, and patients aged ≥70 years show higher prevalence (75%). 5, 3

The metallic taste often coexists with other taste alterations—patients frequently report that everything tastes bitter and that sour foods are particularly bothersome. 3 Importantly, umami taste perception is severely affected in most patients with chemotherapy-induced dysgeusia. 2

Primary Management Strategy: Dietary Modifications

First-Line Interventions

• Use plastic utensils exclusively instead of metal silverware to eliminate direct metal contact with food. 1

• Eat foods cold or frozen rather than hot, as temperature reduction decreases taste intensity and metallic perception. 1, 4

• Add strong flavoring agents to mask the metallic taste: incorporate robust herbs, spices, sweeteners, or acidic ingredients (lemon juice, vinegar) into meals. 1, 4

• Consume sweet and sour foods together to counterbalance the metallic sensation. 1

• Try "miracle fruit" supplements (Synsepalum dulcificum), which can modify taste perception and reduce metallic taste. 1

• Eat blander foods when strong flavors are intolerable, as some patients find this more tolerable than heavily seasoned options. 4

• Increase water intake with meals to help wash away the metallic taste. 4

Additional Dietary Strategies

• Avoid strong-smelling or strong-tasting foods if they exacerbate symptoms. 4

• Eat smaller, more frequent meals rather than three large meals, which can help manage overall taste disturbances. 4

• Perform oral care before eating (brushing teeth, rinsing mouth) to temporarily improve taste perception. 4

Pharmacologic Interventions for Persistent Symptoms

When dietary modifications are insufficient, consider medication trials. In a case series, 71% of patients reported improvement with pharmacologic treatment. 2

Treatment Options

• Zinc supplementation: Trial zinc supplements, particularly in patients with documented zinc deficiency or prolonged chemotherapy exposure. 2

• Clonazepam: Consider low-dose clonazepam for taste dysfunction. 2

• Megestrol acetate: May improve taste perception while also stimulating appetite. 2

• Dronabinol (cannabinoid): Can be trialed for refractory taste changes. 2

Assessment and Monitoring

• Assess taste changes proactively before they significantly impact nutritional intake, ideally starting after the first or second chemotherapy cycle. 4

• Evaluate for hyposalivation (dry mouth), which occurs in 66-80% of patients with taste changes and compounds the problem. 2

• Document specific taste qualities affected: sweet, sour, salty, bitter, umami, and spicy sensations may be differentially impaired depending on the chemotherapy regimen. 2

Important Clinical Considerations

Provide patient education early: Patients receiving cisplatin, carboplatin, cyclophosphamide, or 5-FU-based regimens should receive counseling about taste changes and management strategies before or immediately after starting chemotherapy, not after symptoms become severe. 4

Recognize variability: Not all patients find metallic taste bothersome despite experiencing it, so tailor interventions to individual distress levels. 3

Monitor nutritional impact: While the provided guidelines focus on antiemetic management rather than dysgeusia specifically 6, taste changes can significantly affect dietary intake and should be addressed to prevent malnutrition. 1

Avoid dismissing the symptom: Although metallic taste receives limited attention in formal oncology guidelines, it is extensively discussed on patient forums and significantly impacts quality of life. 1